Molecular Markers in Cutaneous Squamous Cell Carcinoma

Nonmelanoma skin carcinoma (NMSC) is the most frequent cancer in the USA with over 1.3 million new diagnoses a year; however due to an underappreciation of its associated mortality and growing incidence and its ability to be highly aggressive, the molecular mechanism is not well delineated. Whereas the molecular profiles of melanoma have been well characterized, those for cutaneous squamous cell carcinoma (cSCC) have trailed behind. This importance of the new staging paradigm is linked to the ability currently to better clinically cluster similar biologic behavior in order to risk-stratify lesions and patients. In this paper we discuss the trends in NMSC and the etiologies for the subset of NMSC with the most mortality, cutaneous SCC, as well as where the field stands in the discovery of a molecular profile. The molecular markers are highlighted to demonstrate the recent advances in cSCC

Recipient Vessel Analysis for Microvascular Reconstruction of the Head and Neck

Abstract: The selection of recipient vessels that are suitable for microvascular anastomosis in the head and neck region is one of many components that is essential for successful free tissue transfer. The purpose of this study was to evaluate a set of factors that are related to the recipient artery and vein and to determine how these factors influence flap survival. A retrospective review of 102 patients over a 5-year consecutive period was completed. Indications for microvascular reconstruction included tumor ablation (n ϭ 76), trauma (n ϭ 13), and chronic wounds or facial paralysis (n ϭ 13). The most frequently used recipient artery and vein included the facial, superficial temporal, superior thyroid, carotid, and jugular. Various factors that were related to the recipient vessels were analyzed and included patient age, recipient artery and vein, diabetes mellitus, tobacco use, the timing of reconstruction, the method of anastomosis, previous radiation therapy, creation of an arteriovenous loop, and use of an interposition vein graft. Successful free tissue transfer was obtained in 97 of 102 flaps (95%). Flap failure was the result of venous thrombosis in 4 and arterial thrombosis in 1. Statistical analysis demonstrated that anastomotic failure was associated with an arteriovenous loop (2 of 5, P ϭ 0.03) and tobacco use (3 of 5, P ϭ 0.03). Flap failure was not related to patient age, choice of recipient vessel, diabetes mellitus, previous irradiation, the method of arterial or venous anastomosis, use of an interposition vein graft, or the timing of reconstruction. 2004;52: 148 -155) T he selection of recipient vessels that are suitable for microvascular anastomosis within the head and neck is an important component affecting patency. The vascular anatomy of the head and neck is complex with numerous arteries and veins from which to choose. (Ann Plast Surg 1,2 The decision is usually based on the location of the defect and the proximity of a recipient artery and vein. Recipient vessels that are in close proximity to the defect are usually anastomosed to the donor vessels in an end-to-end or end-to-side fashion. However, in circumstances in which the local vascular access is not available or when the quality of the local vasculature is inadequate, remote vascular access could be required. 3,19 -21 Other factors such as the timing of reconstruction, 22 method of anastomosis, MATERIALS AND METHODS This is a retrospective review of 102 patients over a 5-year consecutive period. Included were 73 men and 29 women with a mean age of 53 years (range, 10 -85 years). Indications for microvascular reconstruction included tumor ablation in 76 patients, trauma in 13 patients, and chronic wounds or facial paralysis in 13 patients. The location of the defects, types of flaps, recipient arteries, and recipient veins are listed i

Frameless stereotaxy in a transmandibular, circumglossal, retropharyngeal cervical decompression in a klippel-feil patient: technical note

Frameless stereotaxy, while most commonly applied to intracranial surgery, has seen an increasing number of applications in spinal surgery. Its use in the spine has been described to a greater degree in posterior rather than anterior surgical approaches, presumably due to the relative paucity of anatomical landmarks appropriate for frameless stereotactic registration in the anterior spine. This technical note illustrates the previously undescribed, successful use of frameless stereotaxy to the transmandibular, circumglossal, retropharyngeal surgical approach in a patient with Klippel-Feil syndrome